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Florida Blue Becomes First U.S. Payer to Use AI In Health Insurance for Prior Authorization Approvals

In a first-of-its-kind development, insurer Florida Blue will now automate prior authorization using clinical reviews powered by artificial intelligence (AI).

This new application of AI in health insurance will allow faster care for patients and decrease the administrative workloads faced by providers and healthcare systems.

GuideWell, the parent company of Florida Blue, and Olive, an AI-based healthcare automation company, announced a partnership to enable AI clinical reviews of prior authorization approvals. This automated process is designed to provide patients with more immediate access to information about their coverage while reducing the work that providers go through to complete the prior authorization process.

The companies plan to begin rolling out the AI platform in April, with a full-scale implementation in July for more than 2.5 million Florida Blue members.

Florida Blue (2)This collaboration, announced on Feb. 16, comes after a pilot program trialed by the two companies in 2021. According to a news release, the trial program reduced decision times by 10 days and led to a 27% decrease in unnecessary prior authorization requests.

“Olive’s AI platform helps GuideWell create a best-in-class utilization management model that reduces the administrative burden on our providers while creating a better experience for our members,” said Elana Schrader, MD, Senior Vice President of Healthcare Services at GuideWell and President of GuideWell Health. “By being the first health plan to automate approvals, we are leading the way for insurers to close the technology gap to better serve our members and providers.”

Nearly All Physicians Report Delays Due to Prior Authorization Process

This new approach offers a potential fix to the burdensome process of prior authorization for physicians.

A 2021 American Medical Association (AMA) survey found that 93% of physicians reported prior authorization causes treatment delays and that 82% reported that the prior authorization process causes their patients to abandon planned care.

Perhaps more importantly, the AMA survey indicated that physicians’ perception of the prior authorization process on clinical outcomes was that it made a “somewhat or significant negative impact” for 91% of those surveyed. Additionally, 34% of physicians even reported that the prior authorization process led to a serious adverse event to one or more of their patients.

Beyond the potential clinical effects that the burden of prior authorization creates, it also adds significantly to practices’ administrative costs and time. The AMA survey found that the average practice spends about 13 hours each week completing prior authorizations and that two in five physicians employ staff members who exclusively work on prior authorizations.

Cost Reductions can be Realized Through AI in Health Insurance

Olive’s AI platform will prepare, submit, and deliver payer-approved prior authorizations. In doing so, Olive and GuideWell hope to fix “one of the most broken processes in healthcare today,” said Jeremy Friese, MD, President of Payer Market at Olive.

Having a streamlined, automated prior authorization process offers benefits to providers and payers, decreasing the workload on both sides of this process. Healthcare leaders will recognize that time and costs can be reduced using AI in health insurance.

While AI-directed prior authorization processes are only just becoming available, healthcare leaders can encourage payers to offer similar technologies, lowering the costs and improving the speed of healthcare through AI.

—Caleb Williams

Related Resources:

Florida Blue

Olive

GuideWell and Olive Debut First-Of-Its-Kind AI Solution to Accelerate Access to Health Care

2021 AMA prior authorization (PA) physician survey